Uterine preservation in pelvic organ prolapse.

Background and Objective: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life and frequently requires surgical management. Historically, hysterectomy was considered the standard approach to prolapse repair; however, increasing recognition of patient preference and advances in surgical techniques have led to greater adoption of uterine-preserving procedures. Hysteropexy has emerged as a viable alternative to hysterectomy in appropriately selected patients. This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes. Methods: This narrative review was developed through a comprehensive review of the available literature on uterine-preserving surgery for POP. Studies were selected based on relevance to uterine-preserving prolapse repair, with emphasis placed on high-quality evidence, including randomized controlled trials, systematic reviews, meta-analyses, large observational studies, and contemporary publications. Historical studies were included when relevant to the development and evolution of specific surgical techniques. Key Content and Findings: This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes. Available data suggest that hysteropexy provides similar short- to intermediate-term anatomic and subjective outcomes compared with hysterectomy with apical suspension. Uterine preservation is associated with decreased operative time, reduced blood loss, and, in mesh-augmented repairs, a lower risk of mesh exposure.Multiple surgical approaches are described, including vaginal, abdominal, laparoscopic, and robotic techniques, each with distinct advantages and limitations. Patient preference remains a key driver in decision-making, with many individuals favoring uterine conservation for personal, cultural, and psychosocial reasons. However, factors such as advanced prolapse, cervical elongation, and risk of gynecologic malignancy must be carefully considered. Conclusions: Overall, hysteropexy represents a safe and effective option for the management of POP, although long-term durability data remain limited. Continued research is needed to better define optimal patient selection and long-term outcomes.